The myth of CPR

The international attention over the incident concerning an independent living facility's refusal to give CPR, as a matter of policy, has inspired a lot of clutching of pearls regarding long-term care's medical ethics.

Anthony Cirillo, a frequent contributor to McKnight's, weighed in yesterday, saying that a facility's policy should not outweigh common sense. I don't disagree that Glenwood's policy could use a review.

But there were a few big facts that got left out of the original reporting. Glenwood is an independent living facility, not a nursing home, and the staff member who refused to do CPR on Lorraine Bayless was a resident service director, not a nurse.

The biggest item of interest, to me, however, is that the family of the resident issued an eloquent statement that said the 87-year-old Bayless had not wanted life-sustaining measures.

Perhaps they, unlike many families' members, realized that CPR is one of many avenues that could have left their loved on in a vegetative state. If so, they are ahead of the vast majority of the population in understanding CPR's limits.

An article in Journal of the American Medical Association last year reflected what those in the medical profession already knew: CPR's rate of effectiveness in helping a person to fully recover is slim. In the JAMA study, around 18% of those who had CPR and epinephrine achieved a momentary reprieve, but fewer than 5% lived for a month. Fewer than 2% survived for a month with good or moderate cerebral performance. An earlier study found that long-term survival — defined as two weeks — was about 16% when a bystander did CPR correctly.

One physician wrote last year, “If I drop dead on the street, observed or unobserved, I suppose the observer will feel obligated to call 911, but please do not administer closed chest cardiac massage to me.”

As healthcare advocates, we have good reasons for promoting CPR training: In cases involving a child who has fallen into a pool, for example, it can absolutely be lifesaving. For many of us, we'd feel, as the physician above surmised, obligated to try to help someone we saw collapse.

In my previous job, I remember a hospital clinical leader talking how we should know CPR, but to know it didn't always work. In one case in particular, she said she saw a male nurse jump over the banister and down nearly a flight of stairs to immediately start working on a man who had collapsed. You would think that man was fortunate in that he collapsed at a hospital where dedicated staff members literally sprang into action. It didn't make a difference.

We do a disservice to not only families and residents, but also employees, when we join in a CPR hallelujah chorus. In the case of Bayless, it's one thing to criticize a policy, but it's another to imply that a better employee would have been able to save her life.